The rural Southern United States demonstrates substantial need for effective HIV prevention and treatment services to address the wide disparities in HIV/AIDS rates in African Americans as compared to Whites. Because resources are limited in rural areas, it is important that HIV testing and other prevention activities target those populations at highest risk, including African-American cocaine users. However, little research exists about rural African-American cocaine users'help-seeking behavior, experiences, perceptions, and preferences regarding HIV testing and prevention services. Nor do we understand the barriers and facilitators that substance use treatment and other service providers perceive to integrating HIV testing into their programs. The aims of this revision to R01DA024575 are to study stakeholder perspectives of HIV testing services (1) to identify and characterize settings and organizations that offer HIV testing services available to rural African-American cocaine users;(2) to develop a grounded theory of help-seeking decisions among rural African-American cocaine users based on their preferences and perceptions of barriers and facilitators for using HIV testing/prevention resources;(3) to use organizational change models to identify the barriers and facilitators to providing these services in substance use treatment and other locations based on the attitudes and perceptions of administrators, front-line providers, and users;and (4) to develop and disseminate a set of recommendations for service providers and policy makers to deliver and enhance utilization of HIV testing and services in rural areas. To accomplish this, we will use qualitative methods to interview and conduct focus groups with approximately 98 rural African-American cocaine users in the two counties, and approximately 40 administrators/policymakers at the state level, regional program administrators, and local front-line providers. This study design will provide a thorough diagnostic assessment of the structural and contextual barriers and facilitators to integrating HIV testing in substance abuse treatment and other community locations from the perspectives of all major stakeholders, and inform the generation of grounded theory about help-seeking decisions among the study community. This project will have a significant impact on the delivery of HIV testing programs and a variety of treatment systems and service programs for substance users in the study community, but beyond the local impact of this research, the process findings from this research will be disseminated as a model for conducting systematic evaluation of contextual and structural factors in other rural communities. These findings will contribute critically important information to develop strategies that can address the growing disparities in HIV and rapid growth of the epidemic among African Americans in rural areas. PUBLIC HEALTH RELEVANCE: The project will provide critically-needed information about the structural and system factors that influence integration of HIV testing services into rural substance use and other service delivery systems, and factors that influence HIV testing utilization among African-American substance users. As a result the study team will be able to develop recommendations for consumers, service providers and policy makers to enhance utilization of HIV testing and services in rural areas for high-risk populations. This research can thus make important contributions in the development of systems-level interventions to increase HIV testing and counseling, thus reducing the spread and impact of the epidemic in a disproportionately-affected, under-resourced population.